Mineral Bone Disease Prevalence and Biochemical Profile in Chronic Kidney Disease Patients Undergoing Hemodialysis

TL;DR

This study examines the prevalence and biochemical characteristics of mineral bone disease in Indian patients with advanced kidney disease undergoing hemodialysis.

Contribution

The study provides insights into the biochemical profiles and prevalence of mineral bone disease in a specific Indian hemodialysis patient population.

Findings

Low-turnover mineral bone disease was most common, affecting 43.4% of patients.

Vitamin D insufficiency was present in 57.9% of patients, with 11.8% having a deficiency.

Total alkaline phosphatase levels correlated significantly with parathyroid hormone levels.

Abstract

Introduction

Mineral bone disease (MBD) is a common complication in patients with stage 5 chronic kidney disease (CKD) undergoing maintenance hemodialysis. This study aimed to evaluate the prevalence and biochemical profiles of MBD in this patient population in India.

Methods

This cross-sectional study was conducted at a tertiary hospital in southern India over a period from June 2020 to November 2021 with 152 patients with stage 5 chronic kidney disease (CKD) undergoing maintenance hemodialysis for at least three months. Blood samples were collected prior to routine dialysis sessions to assess levels of calcium, phosphate, intact parathyroid hormone (iPTH), 25-hydroxy vitamin D, bone-specific alkaline phosphatase (BSAP), and total alkaline phosphatase (ALP). Patients were categorized based on their iPTH levels into four distinct groups: < 2 times, 2 to 5 times, 5 to 9 times, and > 9 times the upper normal limit (which is 65 pg/ml).

Results

Low-turnover MBD (iPTH < 2 times the upper limit) was predominant with 66 (43.4%) patients, whereas 17 (11.18%) patients had high-turnover MBD (iPTH > 9 times the upper limit). Hypocalcemia and hypercalcemia affected 42 (27.6%) and 14 (9.2%) patients, respectively. Vitamin D insufficiency was found in 88(57.9%) patients, and deficiency was found in 18 (11.8%) patients. BSAP levels were predominantly high (≥27 IU/L) across all iPTH groups, with no statistically significant variation. In contrast, total alkaline phosphatase (ALP) levels showed a significant positive correlation with iPTH levels (p=0.001), with higher iPTH levels associated with a greater proportion of ALP values > 110 IU/L. These findings underscore the high prevalence of MBD in Indian patients with CKD on hemodialysis, emphasizing the need for biochemical monitoring to facilitate early detection and optimal management for improved outcomes.

Conclusion

The high prevalence of MBD in Indian patients with CKD on hemodialysis underscores the need for regular biochemical monitoring. Early detection and optimal management strategies are essential to improve patient outcomes.

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